Division of Cardiac Surgery, University of Maryland, Baltimore, Maryland.
Division of Cardiac Surgery, University of Maryland, Baltimore, Maryland.
Ann Thorac Surg. 2018 Sep;106(3):778-783. doi: 10.1016/j.athoracsur.2018.02.079. Epub 2018 Apr 4.
Thrombus located distal to the main or primary pulmonary arteries has been previously viewed as a relative contraindication to surgical pulmonary embolectomy. We compared outcomes for surgical pulmonary embolectomy for submassive and massive pulmonary embolism (PE) in patients with central vs peripheral thrombus burden.
All consecutive patients (2011 to 2016) undergoing surgical pulmonary embolectomy at a single center were retrospectively reviewed. Computed tomography angiography of each patient was used to define central PE as any thrombus originating within the lateral pericardial borders (main or right/left pulmonary arteries). Peripheral PE was defined as thrombus exclusively beyond the lateral pericardial borders, involving the lobar pulmonary arteries or distal. The primary outcome was in-hospital and 90-day survival.
We identified 70 patients: 52 (74%) with central PE and 18 (26%) with peripheral PE. Preoperative vital signs and right ventricular dysfunction were similar between the two groups. Compared with the central PE cohort, operative time was significantly longer in the peripheral PE group (191 vs 210 minutes, p < 0.005). Median right ventricular dysfunction decreased from moderate dysfunction preoperatively to no dysfunction at discharge in both groups. Overall 90-day survival was 94%, with 100% survival in patients with submassive PE in both cohorts.
This single-center experience demonstrates excellent overall outcomes for surgical pulmonary embolectomy, with resolution of right ventricular dysfunction and comparable morbidity and mortality for central and peripheral PE. In an experienced center and when physiologically warranted, surgical pulmonary embolectomy for peripheral distribution of thrombus is technically feasible and effective.
以前，位于主肺动脉或原发性肺动脉远端的血栓被视为外科肺动脉血栓切除术的相对禁忌证。我们比较了中心型和外周型血栓负荷患者接受外科肺动脉血栓切除术治疗亚大块和大块肺栓塞（PE）的结果。
回顾性分析了 2011 年至 2016 年期间在单一中心接受外科肺动脉血栓切除术的所有连续患者。每位患者的计算机断层血管造影术用于定义中央型 PE，任何起源于外侧心包边界（主肺动脉或左右肺动脉）内的血栓。外周型 PE 定义为仅位于外侧心包边界以外，累及肺叶肺动脉或远端的血栓。主要结局是院内和 90 天生存率。
我们共确定了 70 例患者：52 例（74%）为中央型 PE，18 例（26%）为外周型 PE。两组患者术前生命体征和右心室功能障碍相似。与中央型 PE 组相比，外周型 PE 组的手术时间明显更长（191 分钟与 210 分钟，p < 0.005）。两组患者的右心室功能障碍均从中度障碍术前降至出院时无功能障碍。整体 90 天生存率为 94%，两组亚大块 PE 患者的生存率均为 100%。
本单中心经验表明，外科肺动脉血栓切除术的总体结果非常出色，右心室功能障碍得到缓解，中央型和外周型 PE 的发病率和死亡率相当。在经验丰富的中心，当生理上需要时，对血栓外周分布进行外科肺动脉血栓切除术在技术上是可行和有效的。
